Paracetamol known as acetaminophen and APAP, is a medication used to treat pain and fever. It is used for mild to moderate pain relief. There is mixed evidence for its use to relieve fever in children, it is sold in combination with other medications, such as in many cold medications. Paracetamol is used for severe pain, such as cancer pain and pain after surgery, in combination with opioid pain medication, it is used either by mouth or rectally, but is available by injection into a vein. Effects last between four hours. Paracetamol is safe at recommended doses; the recommended maximum daily dose for an adult is three to four grams. Higher doses may lead including liver failure. Serious skin rashes may occur, it appears to be safe during pregnancy and when breastfeeding. In those with liver disease, it may still be in lower doses, it is classified as a mild analgesic. It does not have significant anti-inflammatory activity. How it works is not clear. Paracetamol was first made in 1877, it is the most used medication for pain and fever in both the United States and Europe.
It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. Paracetamol is available as a generic medication with trade names including Tylenol and Panadol, among others; the wholesale price in the developing world is less than US$0.01 per dose. In the United States, it costs about US$0.04 per dose. In 2020, it was the 25th most prescribed medication in the United States, with more than 24 million prescriptions. Paracetamol is used for reducing fever in people of all ages; the World Health Organization recommends that paracetamol be used to treat fever in children only if their temperature is higher than 38.5 °C. The efficacy of paracetamol by itself in children with fevers has been questioned and a meta-analysis showed that it is less effective than ibuprofen. Paracetamol does not have significant anti-inflammatory effects. Paracetamol is used for the relief of mild to moderate pain; the use of the intravenous form for short-term pain in people in the emergency department is supported by limited evidence.
The American College of Rheumatology recommends paracetamol as one of several treatment options for people with arthritis pain of the hip, hand, or knee that does not improve with exercise and weight loss. A 2015 review, found it provided only a small benefit in osteoarthritis. Paracetamol has little anti-inflammatory activity, unlike other common analgesics such as the nonsteroidal anti-inflammatory drugs aspirin, ibuprofen, but ibuprofen and paracetamol have similar effects in the treatment of headache. Paracetamol can relieve pain in mild arthritis, but has no effect on the underlying inflammation and swelling of the joint, it has analgesic properties comparable to those of aspirin, while its anti-inflammatory effects are weaker. It is better tolerated than aspirin due to concerns about bleeding with aspirin. Based on a systematic review, paracetamol was recommended by the American College of Physicians and the American Pain Society as a first-line treatment for lower back pain; the American College of Physicians, as of 2017, noted evidence that it was no different than placebo in the treatment of nonradicular low back pain.
Other systematic reviews have concluded that evidence for its efficacy is lacking. A joint statement of the German and Swiss headache societies and the German Society of Neurology recommends the use of paracetamol in combination with caffeine as one of several first-line therapies for treatment of tension and migraine headaches. In the treatment of acute migraine, it is superior to placebo, with 39% of people experiencing pain relief at one hour compared with 20% in the control group. Paracetamol combined with NSAIDs may be more effective for treating postoperative pain than either paracetamol or NSAIDs alone. NSAIDs such as ibuprofen and diclofenac are more effective than paracetamol for controlling dental pain or pain arising from dental procedures. Paracetamol is useful when NSAIDs are contraindicated due to hypersensitivity or history of gastrointestinal ulceration or bleeding, it can be used in combination with NSAIDs when these are ineffective in controlling dental pain alone. The Cochrane review of preoperative analgesics for additional pain relief in children and adolescents shows no evidence of benefit in taking paracetamol before dental treatment to help reduce pain after treatment for procedures under local anaesthetic, but the quality of evidence is low.
The efficacy of paracetamol when used in combination with weak opioids improved for about 50% of people, but with increases in the number experiencing side effects. Combination drugs of paracetamol and strong opioids such as morphine improve analgesic effect; the combination of paracetamol with caffeine is superior to paracetamol alone for the treatment of common pain conditions, including dental pain, post partum pain, headache. Paracetamol is used to treat patent ductus arteriosus, a condition that affects newborns when a blood vessel used in developing the lungs fails to close as it does, but evidence for the safety and efficacy of paracetamol for this purpose is lacking. NSAIDs indomethacin and ibuprofen, have been used, but the evidence for them is not strong; the condition appears to be caused in part by overactive prostaglandin E2, signalling through its EP4 receptor, but also through its EP2 receptor and EP3 receptors. Healthy adults taking regular doses up to 4,000 mg a day show little
Johan Bernt Krohg Heiberg was a Norwegian architect. He was born in Norway, he was the son of his wife Ragnhild Krohg. He had two brothers: Edvard Heiberg. In 1935, Heiberg married Halldis Rollang. Heiberg took examen artium in 1927, he thereafter moved to Trondheim. In 1936, he was hired as an assistant by Frithjof Stoud Platou. Four years he started his own architectural firm in Oslo. In the 1950s, Heiberg designed many buildings for the housing cooperative Oslo Bolig- og Sparelag and Christiania Bank, he designed many buildings with Ola Mørk Sandvik until 1968, among them the head office of the Norwegian Ministry of Foreign Affairs in Oslo, the restaurant Annen Etage and the Hotel Continental. Heiberg's buildings were designed in functionalist style, which he considered "architecture for living people"; when it came to politics, Heiberg was a leftist. However, despite his being a supporter of the communist league Mot Dag in the 1930s, Heiberg opposed the May 1968 revolts, stating that he "with shame had to admit, tired of the whole thing".
From 1961 to 1971, Heiberg headed the Society for the Preservation of Ancient Norwegian Monuments. He headed the board of the National Museum of Art and Design from 1978 to 1981. In 1950, he was decorated as a Commander of the Royal Norwegian Order of St. Olav, he died on 29 September 2001
Sensate focus is a sex therapy technique introduced by the Masters and Johnson team. It works by refocusing the participants on their own sensory perceptions and sensuality, instead of goal-oriented behavior focused on the genitals and penetrative sex. Sensate focus has been used to treat problems with body image, erectile dysfunction, orgasm disorders, lack of sexual arousal; the exercises are conducted by the couple between therapy sessions. Although the couple are nude and touching each other during the exercises, they are instructed to abstain from sexual intercourse during or close to the sessions. Both participants are instructed instead to focus on their own varied sense experience, instead of focusing on performance or orgasm; the emphasis is on touching in a mindful way for oneself without regard for sexual response or pleasure for oneself or one’s partner. A sex therapist will guide the timing and technique of the sensate focusing. In the first stage, the couple may touch each other's bodies excluding genitals.
They are encouraged to enjoy and become aware of the warmth and other qualities of their partner's skin. Participants attend to whatever they find interesting in each other, rather than attend to what they think the other wants. Contact with the breasts, or male or female genitalia is banned at least for the first initial session, but other aspects of intimacy are explored: touching, hugging, so on; this includes taste and sound, as partners are encouraged to talk to each other, to express emotion, to encourage each other. The aim here is to minimize pressure and expectations, to appreciate new sensual possibilities. Patients report an improvement in their sex life with less anxiety; as the man reports increasing awareness and attention paid to these holistic sense aspects of sex, potency returns. This works well for women too. Women report more sensation in their vagina, lubrication; the second stage increases the touch options to include breasts. Sensation and gathering information about the partner's body is still encouraged and intercourse and touching of the genitals is still forbidden.
The participants use a technique of placing their hand over their partner's hand in order to show what they find pleasurable in terms of pace and pressure. Learning about the partner's body is still the goal rather than pleasure. Further stages re-introduce touching of breasts and genitals intercourse. Orgasm is never the focus; this is used as a treatment for impotence in males, arousal difficulties where anxiety is involved. Because of performance anxiety in men, the obsessional focus on the penis can result in impotence; the therapist will encourage the man to forget about his penis, forget about his partner's genitals, instead concentrate on the sensual possibilities available in the feel of his own and his partner's skin, mouth, etc